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Searching for strengths, not symptoms

November 19, 2010
by H. Steven Moffic, MD
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Hide not your talents. They for use were made. What’s a sundial without the sun? -Benjamin Franklin

Just the other day, actually on Election Day, a patient came into my office with a laptop computer. The way he had it open made me wonder if he wanted to show me something. But I also knew we only had the usual 20 minutes to review his medications and complete the EMR.

He quickly told me his medications for ADHD and Dysthymia were working fine. The big problem, as so many other patients have cried to me recently, was that he was still unable to find work after he was laid off months ago. One would have thought he too would be despondent, or advocate for some new politicians to get our economy going (and sure enough, the Republicans had taken over in Wisconsin), but no. He seemed excited and positive. I wondered, was he getting a little hypomanic? Was he taking too many Concertas for his ADHD and getting overstimulated? As it turns out, no and no again.

What he was excited about, and wanted to share with me, was how he was changing his job search strategy. He had concluded that maybe he needed to hone in on his strengths, including personal characteristics. He asked if I was familiar with StrengthFinders 2.0. I wasn’t. He said it was being used more and more by businesses in hiring. Then, he also said that he got Face Book feedback from all his “friends”. He concluded that creativity and humor were his best selling points. We finished – after going overtime with 30 minutes – by his showing me an ideogram of his relative strengths.

Now, I’m not sure if this discussion of strengths was necessarily therapeutic. Certainly, as far as his targeted symptoms, no. However, it definitely expanded my knowledge, sympathy, and empathy about him.

Taking off from the work of Carl Rogers, research has long supported the idea that clinicians who provide patient care with high levels of empathy, warmth, and positive regard correlate significantly with successful patient outcomes, whether psychotherapy and/or some sort of medication was provided. This is not to say that being empathetic is easy, as it requires being in touch with various aspects of ourselves (some of which we’d rather ignore), as well as cross-cultural sensitivity.

Not long before this example, I was also impressed with how focusing on strengths was helping in a different context. In Houston (Harris County MHMRA), there is a Consumer Council that helps monitor, review, and advise administration about all the programs. The leader many years ago had decided that he should look for strengths in patients, besides their symptoms and weaknesses. He had been surprised to see voluminous charts without any mention of patient strengths. So he went on what he called “treasure hunts” and found patients enthusiastic to discuss what they had loved doing, from golfing to making coffee. And, lo and behold, as he paid attention to their strengths, some unexpected improvement in their functioning and self-esteem emerged.

All of this got me wondering. Do we still not pay enough attention to the strengths in those we serve? Is there any item in our paper or electronic records where those should be recorded? If not, should there be? I’ve seen such an item occasionally, such as “Description of Patient Strengths”, but what I then find is a description of strengths only so far as symptoms, such as “She has very good insight into her illness”. I see very little about the treasures in our patients.

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Amen, Dr. Moffic! I remember a time (fortunately, years ago) when there wasn't even a place on our treatment plan to identify strengths. It was truly transformational when we implemented strengths-based and person centered service planning within our organization. We also have a Consumer Advisory Board and I HIGHLY recommend it to everyone. We have received much wise advice over the years from our consumers. More evidence of the many, many capabilities that are out there, just waiting to be tapped.

Good, thought-provoking column. I envy you for having a session like the one you described.

"You would think, that given our knowledge of psychology, that we would be superb at hiring"

My knowledge of the research is that most managers in any field don't do much better than a coin toss in predicting who will be better and worse employees. I suspect that this is due to the highly limited nature of most hiring processes and the fact (or so I've read) that we tend to make judgements about people within the first 20 seconds to a minute, and then initial judgements have to be undone by subsequent information. Most places I've worked also did not put applicants in multiple assessment situations for example, interviews with several staff, plus interviews with the staff as a group, so that all the interviewers could later compare notes, which offers some corrections for biased judgments. And I've only applied at one place where someone actually asked me what I would do in a particular situation.
Finally, desperation in times of limited funding and high turn-over rates encourages grabbing who you can, as long as they aren't obviously impaired.
I don't think that looking for strengths more than we do would help this, but later support and strength-focus certainly would help in retention and remediation when needed.

"and working together on teams."
Many MH organizations discourage teams or don't use them, so that's an organizational culture issue. Teams are groups, and like any other groups, they depend on the mix of people. Some groups work well and some don't, and there aren't always ways to alter that with more understanding or support.

In this general area, I am most dismayed that most Recovery literature that I've read does not apply the same standards to staff as to consumersas if you can ignore providing respect and empathy and empowerment to your staff and then expect them to do a good job in providing this to consumers. It is ironic to hear administrators/supervisors, with no discussion or warning to staff, schedule a mandatory training on Recovery so the staff can learn how to be respectful to consumers and involve them in decisions that affect them.
I now think that the consumer peer specialists are going to experience the same quality-impairing staff experiences that the regular staff have always confronted, so maybe they will be able to be a more vocal group in insisting on a better workplace at many organizations.

A last picky point:

"Taking off from the work of Carl Rogers, research has long supported the idea that clinicians who provide patient care with high levels of empathy, warmth, and positive regard correlate significantly with successful patient outcomes"

I think it would be more correct to say that patients who **perceive** clinicians as having high levels of empathy etc. often have better outcomes.


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H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...